Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, the Netherlands.
Acta Obstet Gynecol Scand. 2013 Jan;92(1):85-93. doi: 10.1111/aogs.12012. Epub 2012 Nov 5.
To assess substandard care factors in the case of delivery-related asphyxia.
Prospective cohort study.
Catchment area of the Neonatal Intensive Care Unit (NICU) of the University Medical Center Utrecht; a region in the middle of the Netherlands covering 13% of the Dutch population.
Term infants, without congenital malformations, who died intrapartum or were admitted to the Neonatal Intensive Care Unit due to asphyxia.
During a two-year period, cases were prospectively collected and audited by an expert panel.
Substandard care factors.
37 735 term infants without congenital malformations were born. There were 19 intrapartum deaths, and 89 NICU admissions of which 12 neonates died. In 63 (58%) cases a substandard care factor was identified that was possibly (n= 47, 43%) or probably (n= 16, 15%) related to perinatal death or NICU admission. In primary care, substandard care factors were mainly the low frequency of examination during labor and delay in referral to secondary care. In secondary care, misinterpretation of cardiotocography and failure to respond adequately to clinical signs of fetal distress were the most common substandard care factors.
Substandard care is present in a substantial number of cases with delivery-related asphyxia resulting in perinatal death or NICU admission. Improving the organization of obstetric care in the Netherlands as well as training of obstetric caregivers might reduce adverse outcomes.
评估与分娩相关窒息病例中的护理不足因素。
前瞻性队列研究。
乌得勒支大学医学中心新生儿重症监护病房（NICU）的集水区；荷兰中部地区，覆盖荷兰人口的 13%。
足月、无先天畸形的婴儿，在分娩过程中死亡或因窒息而入住新生儿重症监护病房。
在两年期间，通过一个专家小组对病例进行前瞻性收集和审核。
护理不足因素。
共有 37735 名无先天畸形的足月婴儿出生。有 19 例分娩中死亡，89 例 NICU 入院，其中 12 例新生儿死亡。在 63 例（58%）病例中发现了护理不足因素，这些因素可能（n=47，43%）或很可能（n=16，15%）与围产期死亡或 NICU 入院有关。在初级保健中，护理不足的主要因素是分娩期间检查频率低，以及向二级保健机构转诊延迟。在二级保健中，最常见的护理不足因素是对胎心监护图的错误解读以及未能对胎儿窘迫的临床迹象做出充分反应。
在与分娩相关的窒息导致围产期死亡或入住新生儿重症监护病房的大量病例中存在护理不足。改善荷兰产科护理的组织以及产科护理人员的培训可能会降低不良结局的发生。
